PubMed Health⌕ Search

Biomedical subjects

H McGuire

Publications and source records attributed to H McGuire.

13 recordsLinked to original sources
PubMed2004

Exercise therapy for chronic fatigue syndrome.

BACKGROUND: Chronic fatigue syndrome (CFS) is an illness characterised by persistent medically unexplained fatigue. CFS is a serious health-care problem with a prevalence of up to 3%. Treatment strategies for CFS include psychological, physical and pharmacological interventions. OBJECTIVES: To investigate the relative effectiveness of exercise therapy and control treatments for CFS. SEARCH STRATEGY: CCDANCTR-Studies and CENTRAL were searched using "Chronic Fatigue" and Exercise. The Journal of Chronic Fatigue Syndrome and CFS conferences were handsearched. Experts in the field were contacted. Clinicaltrials.gov and controlled-trials.com were searched. SELECTION CRITERIA: Only Randomised Controlled Trials (RCT) including participants with a clinical diagnosis of CFS and of any age were included. DATA COLLECTION AND ANALYSIS: The full articles of studies identified were inspected by two reviewers (ME and HMG). Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95% confidence intervals. One sensitivity analysis was undertaken to test the robustness of the results. MAIN RESULTS: Nine studies were identified for possible inclusion in this review, and five of those studies were included. At 12 weeks, those receiving exercise therapy were less fatigued than the control participants (SMD -0.77, 95% CIs -1.26 to -0.28). Physical functioning was significantly improved with exercise therapy group (SMD -0.64, CIs -0.96 to -0.33) but there were more dropouts with exercise therapy (RR 1.73, CIs 0.92 to 3.24). Depression was non-significantly improved in the exercise therapy group compared to the control group at 12 weeks (WMD -0.58, 95% CIs -2.08 to 0.92). Participants receiving exercise therapy were less fatigued than those receiving the antidepressant fluoxetine at 12 weeks (WMD -1.24, 95% CIs -5.31 to 2.83). Participants receiving the combination of the two interventions, exercise + fluoxetine, were less fatigued than those receiving exercise therapy alone at 12 weeks, although again the difference did not reach significance (WMD 3.74, 95% CIs -2.16 to 9.64). When exercise therapy was combined with patient education, those receiving the combination were less fatigued than those receiving exercise therapy alone at 12 weeks (WMD 0.70, 95% CIs -1.48 to 2.88). REVIEWERS' CONCLUSIONS: There is encouraging evidence that some patients may benefit from exercise therapy and no evidence that exercise therapy may worsen outcomes on average. However the treatment may be less acceptable to patients than other management approaches, such as rest or pacing. Patients with CFS who are similar to those in these trials should be offered exercise therapy, and their progress monitored Further high quality randomised studies are needed.

Depression↗
PubMed2003

Low dosage tricyclic antidepressants for depression.

BACKGROUND: Tricyclic antidepressants are still extensively prescribed worldwide. Evidence for the recommended dosage of tricyclics, however, is poor. OBJECTIVES: To compare the effects and side effects of low dosage tricyclic antidepressants with placebo and with standard dosage tricyclics in acute phase treatment of depression. SEARCH STRATEGY: Electronic search of the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR), incorporating results of group searches of MEDLINE (1966-), EMBASE (1980-), CINAHL (1982-), PsycLIT (1974-), PSYNDEX (1977-) and LILACS (1982-1999) and hand searches of major psychiatric and medical journals. Reference search and SciSearch of the identified studies. Personal contact with authors of significant papers. SELECTION CRITERIA: All randomised controlled trials 1) comparing low dosage TCA (=< 100 mg/d on average at the end of trial) with placebo or 2) comparing low and standard dosages of the same TCA, in acute phase treatment of depressive disorder DATA COLLECTION AND ANALYSIS: Two independent reviewers examined eligibility of the identified studies, and extracted data for outcomes at 1 week, 2 weeks, 4 weeks, 6-8 weeks and later. Main outcome measures were relative risk of response in depression (random effects model), according to the original authors' definition but usually defined as 50% or greater reduction in severity of depression according to the last-observation-carried-forward intention-to-treat method, and relative risks of overall dropouts and dropouts due to side effects. Other outcome measures included worst-case-scenario intention-to-treat analysis of response as defined above (in which dropouts were considered non-responders in the active treatment group and as responders in the comparison group), and standardised weighted mean scores of continuous depression severity scales (usually calculated by last-observation-carried-forward method). MAIN RESULTS: 35 studies (2013 participants) compared low dosage tricyclics with placebo, and six studies (551 participants) compared low dosage tricyclics with standard dosage tricyclics. Low dosage tricyclics, mostly between 75 and 100 mg/day, were 1.65 (95% confidence interval 1.36 to 2.0) and 1.47 (1.12 to 1.94) times more likely than placebo to bring about response at 4 weeks and 6-8 weeks, respectively. Standard dosage tricyclics failed, however, to bring about more response but produced more dropouts due to side effects than low dosage tricyclics. REVIEWER'S CONCLUSIONS: Treatment of depression in adults with low dose tricyclics is justified. However, more rigorous studies are needed to definitively establish the relative benefits and harms of varying dosages.

Antidepressive Agents, Tricyclic↗
PubMed2001

Interventions for vaginismus.

BACKGROUND: Vaginismus is involuntary vaginal muscle contraction which makes sexual intercourse difficult or impossible. It is one of the more common female psychosexual problems. Various therapeutic strategies for vaginismus, such as sex therapy and desensitization, have been considered in uncontrolled studies. OBJECTIVES: The aim of this review is to determine the clinical effectiveness of treatments for vaginismus and also to examine the role of partner participation in the effectiveness of the treatment. SEARCH STRATEGY: The Cochrane Collaboration Depression, Anxiety & Neurosis Controlled Trials Register (Issue 3, 2000), the Cochrane Controlled Trials Register (Cochrane Library, Issue 2, 2000), MEDLINE (1966 to Apr 2000), EMBASE (1980 to Apr 2000), PsycINFO (1967 to April 2000) and CINAHL (1982 to Mar 2000) were searched. The Journal of Sex Research (1974 to 1999), Sexual & Marital Therapy (1986 to 1999), Sexual Dysfunction (1998 to 1999) and the Journal of Sex and Marital Therapy (1974 to 1999) were handsearched. Reference lists and conference abstracts were searched. Experts in the field were contacted regarding unpublished material. SELECTION CRITERIA: Controlled trials comparing treatments for vaginismus with another treatment, a placebo treatment, treatment as usual or waiting list control. DATA COLLECTION AND ANALYSIS: The reviewers extracted data which were verified with the trial investigator. MAIN RESULTS: Two controlled trials were identified although data were only available from one trial. The second trial compared two forms of systematic desensitization and reported no discernible differences between them. REVIEWER'S CONCLUSIONS: In spite of encouraging results reported from uncontrolled series of patients there is very limited evidence from controlled trials concerning the effectiveness treatments for vaginismus. Further trials are need to compare therapies with waiting list control and with other therapies.

Desensitization, Psychologic↗
PubMed1995

Pharmacist-operated drug information centers in the United States.

Pharmacist-operated drug information centers (DICs) in the United States were surveyed to obtain current information on the availability and scope of their services. Questionnaires were mailed in late 1991 to 179 institutions believed to have organized DICs. Topics covered in the questionnaire included staffing, resources, funding, and services provided. The results were compared with previous survey results to identify trends. Through 1992, 120 usable responses were received. Compared with findings from earlier surveys, DICs' affiliations with medical centers and hospitals have declined and affiliations with pharmacy schools have increased. More personnel work in DICs than ever. Computers are now used by nearly every DIC, there is an increased emphasis on quality-assurance programs for services rendered, and many DICs have increased revenue with new and expanded services. Although DICs are no longer increasing in number, their services are becoming more sophisticated.

Drug Information Services↗
PubMed1984

Effects of benztropine mesylate on haloperidol-induced prolactin secretion and serum haloperidol levels in rats.

The effects of benztropine mesylate on haloperidol-induced prolactin secretion and serum haloperidol levels were investigated in 240 rats. Animals were pretreated with benztropine mesylate or saline 20 min prior to receiving haloperidol or saline. Serum prolactin and haloperidol levels were analyzed at six time periods over 150 min. There was no significant difference in prolactin levels of control animals, i.e., saline pretreated/saline treated rats compared to benztropine mesylate pretreated/saline treated rats. Haloperidol caused a significant rise (p less than 0.0001) in serum prolactin compared with controls. The prolactin concentration for the 30-150-min sampling period was significantly higher when the rats received benztropine mesylate prior to haloperidol (p less than 0.05). There was a significant correlation (r = 0.57, p less than 0.001) between serum haloperidol levels and serum prolactin levels in haloperidol-treated animals pretreated with either saline or benztropine mesylate. Additionally, serum haloperidol levels were not significantly different in animals pretreated with benztropine mesylate compared with those pretreated with saline. Thus, the enhancement of prolactin levels by benztropine mesylate was independent of any effect of haloperidol metabolism. This study appears to indicate that in the rat, cholinergic mechanisms exert a weak inhibitory effect on prolactin secretion under conditions of dopamine blockade.

Animals↗
PubMed1979

Effects of pyridoxine hydrochloride (vitamin B6) on chlorpromazine-induced serum prolactin rise in male rats.

To investigate if vitamin B6 inhibits prolactin release and to compare this effect to that of bromocriptine, a known suppressor of prolactin release, a study was conducted in male rats. Animals were pretreated with pyridoxine hydrochloride, pyridoxal hydrochloride, saline, or bromocriptine 30 min prior to receiving varying doses of chlorpromazine hydrochloride. Blood samples were obtained 90 min later and analyzed for serum prolactin by a double-antibody radioimmunoassay. Another study involved pyridoxal hydrochloride and saline pretreatments 30 min prior to doses of chlorpromazine hydrochloride. Blood samples collected 60 min later were also analyzed for serum prolactin. Pyridoxine hydrochloride significantly suppressed the chlorpromazine-induced prolactin rise (p less than 0.01). However, the suppression was significantly less than that produced by bromocriptine (p less than 0.01). Pyridoxal hydrochloride, another natural form of vitamin B6, failed to suppress prolactin under the conditions of both studies. This investigation may lend support to the concept that pyridoxine hydrochloride partially inhibits prolactin by a mechanism not involving dopamine.

Animals↗